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Visc Med. 2016 Aug;32(4):234-238. Epub 2016 Jul 29.

NASH Cirrhosis - the New Burden in Liver Transplantation: How Should It Be Managed?

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Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Division of Gastroenterology and Hepatology, The Medical University of South Carolina, Charleston, SC, USA; Section of Gastroenterology, Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA.
Department of General, Visceral, and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany.



Non-alcoholic fatty liver disease (NAFLD) is a continuously increasing cause of chronic liver disease and a health burden in all populations affected by the obesity and metabolic syndrome pandemic. Cirrhotic alterations or hepatocellular carcinoma developing from NAFLD may require liver transplantation (LTx).


Current literature was screened for data on LTx in the setting of NAFLD.


NAFLD-associated LTx is expected to increase in number and relevance during the next decade. NAFLD is part of the metabolic syndrome and thus connected to various metabolic alterations and comorbidities such as diabetes or hyperlipidemia. Moreover, NAFLD comprises an independent risk factor for cardiovascular and chronic kidney disease, which again are important risk factors for outcome of surgical interventions. Postoperative immunosuppression, possible steatosis of the liver graft, and a continued presence of metabolic alterations may lead to early recurrence of steatosis or even non-alcoholic steatohepatitis. Currently, no data are available on combined approaches of weight loss and LTx for NAFLD.


Specific guidelines on how to manage NAFLD-associated LTx are lacking. This particular situation requires close monitoring of metabolic syndrome-associated comorbidities. NAFLD represents a novel challenge to established LTx procedures.


ASH; Alcoholic steatohepatitis; NAFLD; NASH; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Transplantation

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